Egyptian Heart Journal最新文献

Background/Introduction

The correlation between low body mass index (BMI) and congestive heart failure (obesity paradox) has been described in the literature; However, the association between BMI and clinical outcome measures is not well characterized. Little is known about CHF in the Middle Eastern female population; most of the gender-specific information on heart failure comes from higher income “Western” countries.

Objectives

We aimed to identify the correlation between heart failure patients especially those with low BMI and clinical/safety outcome measures with focusing on female patients subgroup characteristics.

Methods

We performed group comparisons of statistically relevant variables using prospectively collected data of HFrEF patients hospitalized over a 12 month period.

Results

The 167 patients (Group I) enrolled by this study with mean age of 59.64 ± 12.9 years, an EF score of 23.96 ± 10.14, 62.9% had ischemic etiology, 12.5% were smoker, 18% had AF, 31.1% had received ICD/CRT-D and an estimated 8.85 ± 9.5 days length of stay (LOS). The low BMI group of patients (Group II) had means age of 58.7 ± 14.5 years, a significant lower EF score of 20.32 ± 8.58, significantly higher 30, 90 days readmission rates and in-house mortality (22%, 36.6% and 17.1% vs 10.2%, 20.4% and 6.6% respectively) and higher rates of CVA, TIA and unexplained syncope (19.5% vs 7.2%). Similarly, female patients with low BMI (Group IV) had lower EF score of 22.0 ± 53, higher 30,90 days readmission rates and in-house mortality (34.4%,43.8% and 25% vs 13.5%,21.6% and 5.4% respectively) and higher rates of CVA, TIA and unexplained syncope(10% vs 0%).

Conclusion

Our findings showed that heart failure patients with low BMI had poor adverse clinical outcome measures (poor EF, recurrent readmission, mortality and composite rates of CVA, TIA and unexplained syncope) which reflect the effect of obesity paradox in those patients with HFrEF. Female patient subgroup showed similar characteristic findings which also might reflect the value of gender-specific BMI related clinical outcomes.

Background

Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities.

Objectives

To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country.

Methods

Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related.

Results

We recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h.

Conclusion

Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance. We also will provide an insight analysis of some of the available studies and will provide guidance for a management approach based on the available data according to the current guidelines.

Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains a major clinical issue and a challenging condition to treat. Congenital coronary anomalies are likely to be under-recognized, as completing an anatomic assessment in a very large portion of the population would seem unfeasible. However, we present a case report with image of a 49 year old male presented with acute non-ST elevation ACS for which he underwent diagnostic angiography of the coronary system which revealed a common origin of both right and left main coronary artery from right sinus of Valsalva with significant obstructive lesion in the mid segment of right coronary artery. However, due to financial constraints CT angiography could not be done in this patient to identify the detail anatomy and the course of the anomalous left coronary artery origin (L-ACAOS). He was managed medically with dual antiplatelets, beta blockers, nitrates and ACE inhibitors.

Congenitally corrected transposition of the great arteries is a rare heart defect that can be associated with systemic ventricular dysfunction and conduction disturbances. The use of cardiac resynchronization therapy in patients with congenital heart disease is not fully established, and achievement of successful pregnancies after implantation of transvenous, biventricular system has never been described, and which resulted in a significant clinical improvement.

We describe a 33-year-old female with congenitally corrected transposition of the great arteries, who achieved six pregnancies and successful vaginal deliveries. The two last pregnancies were achieved after cardiac resynchronization therapy for systemic ventricular dysfunction and complete heart block. A congenital cardiac disease has been identified in only one offspring.

Background

A substantial fraction of patients with non ST-elevation acute coronary syndrome have an occluded culprit vessel on coronary angiography. Acute coronary occlusion often results in myocardial infarction and loss of systolic function. Identification of these patients may have considerable impact on treatment and prognosis.

Aim

The study aims at investigating role of 2D speckle tracking echocardiography as a non-invasive predictor of acute coronary artery occlusion in patients with non ST-segment elevation myocardial infarction.

Patients

This study was carried on 60 patients with first attack non ST segment elevation myocardial infarction who were admitted to coronary care unit of Ain Shams University Hospitals. All patients underwent thorough history taking, full clinical examination, 12 leads surface ECG, full 2D, M-mode and Doppler echocardiographic study, two-dimensional speckle tracking strain study and coronary angiography.

Results

2D derived peak global longitudinal strain had a highly significant relationship in prediction of the presence of total occlusion, and also number of segments with reduced strain (functional risk area by strain) had a highly significant relationship in prediction of the presence of total occlusion. In this study, 2D derived peak longitudinal strain sensitivity and specificity were 68.9% and 77.7% respectively at a cutoff value of −15.5 while number of segments with reduced longitudinal strain sensitivity and specificity were 63.6% and 77.7% respectively at a cutoff value of 5 segments.

Conclusion

Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

Background

Significant coronary artery stenosis might cause persistently impaired longitudinal left ventricle (LV) function at rest. LV global longitudinal strain (LVGLS) can be accurately assessed by 2D speckle-tracking strain echocardiography(2D-STE).

Objective

We aimed to evaluate the diagnostic accuracy of LV global longitudinal strain obtained by 2D-STE in prediction of severity of CAD.

Methods

Eighty patients with suspected stable angina pectoris were included. They underwent transthoracic echocardiography (TTE) to measure LV ejection fraction, 2-D-STE to measure GLS and coronary angiography (CA). The patients were divided into two groups: group 1 (58 patients) with significant (>70%) CAD, and group 2 (22 patients) with non-significant (<70%) CAD. Images were obtained in the apical long-axis, four-chamber, and two chamber views. Regional longitudinal systolic strain was measured in 17 myocardial segments and averaged to provide global longitudinal strain (LVGLS).

Results

There was significant decrease in GLS in group 1 compared to group 2 (−11.86 ± 2.89% versus −18.65 ± 0.79%, P < 0.000). The optimal cutoff value of GLS for prediction of significant CAD was −15.6% [AUC 0.88, 95% CI 0.78–0.96 p < 0.000]. The sensitivity, specificity and accuracy of GLS for detecting significant CAD were 93.1%, 81.8%,and 90% respectively.There was a significant positive correlation between GLS and EF (r = 0.33; p = 0.036).There was incremental significant decrease in GLS with increasing number of coronary vessels involved.

Conclusion

Measurement of global longitudinal strain using 2D speckle tracking echocardiography is sensitive and accurate tool in the prediction of severe CAD.

Sudden cardiac death in young adults may be associated with rare cardiomyopathies such as left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular (ARVC) cardiomyopathies. LVNC is characterised by hypertrabeculations and deep recesses of the left ventricle. ARVC presents with thin myocardium as a result of extensive fibro-fatty infiltrations. In both conditions, death may be due to arrhythmia, thromboembolic events or heart failure. We report a case of a 21-year old athletic young man who collapsed at the futsal court right after the game. He was resuscitated but expired at the hospital after a brief admission. A week earlier, he had a similar episode of syncope and revived through cardio-pulmonary resuscitation at the site. Post mortem examination showed extensive acute myocardial infarction (AMI) involving the papillary muscles and the left ventricular wall. Features of LVNC were also observed. On top of that, the right ventricle showed patchy thin myocardium as the wall was largely comprised of fat. Histology examination confirmed the presence of AMI and massive fibro-fatty infiltrations of the right ventricle. This unfortunate young man had co-existing cardiomyopathies which is rare indeed. As he succumbed to AMI, this mechanism of death is also uncommonly associated with neither LVNC nor ARVC. In conclusion, young and physically active individuals may not be spared of sudden cardiac death. Mild and non-specific symptoms should not be taken lightly as it may be the subtle signs of cardiomyopathies.

Chronic total occlusion (CTO) is probably caused by thrombus and lipid-rich cholesterol esters that are replaced over time by collagen and calcium deposition. Experimental models showed endothelial cell necrosis in response to vessel ligation, whereas more recent models suggest that the endothelium might retain viability guiding the subsequent development of CTO, including CTO neo-revascularization, which occurs within the lumen and in various layers of the vessel wall, by the release of paracrine substances. It is uncertain whether after CTO recanalization the recovery of anterograde reverses endothelial dysfunction, thus promoting vasodilation and positive remodeling.